Teen relationships have changed dramatically in the digital age. Today, connections often develop through social media, text messages, video chats and location-sharing apps, creating new opportunities for communication – but also new risks for coercion, control and abuse.
Dianne M. Alvarez, DO, Researcher and Resident Physician, Nationwide Children’s Hospital, and Emily Egbert, MAT, MPH, ScM, Researcher, University of Pittsburgh School of Medicine, explore the growing issue of teen digital dating violence, how common it is and what parents, clinicians, educators and communities can do to help young people recognize unhealthy behaviors and build safe, healthy relationships.
Featuring:
Dianne M. Alvarez, DO, Researcher and Resident Physician, Nationwide Children’s Hospital
Emily Egbert, MAT, MPH, ScM, Researcher, University of Pittsburgh School of Medicine
Host/Producer: Carol Vassar
TRANSCRIPT
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Carol Vassar, podcast host/producer (00:12):
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Carol Vassar, podcast host/producer (00:36):
Teenage romantic relationships look very different today than even a generation ago and definitely different from when I was a teen. They may begin on the social media platform du jour or on WhatsApp or on a Twitch chat. And while this evolution has created new opportunities for connection, these same avenues provide new openings for coercion, control, and even abuse in the digital space.
(01:01):
At the 2026 Pediatric Academic Societies meeting in Boston, I sat down with early-career researchers Emily Egbert of the University of Pittsburgh School of Medicine and Dr. Dianne Alvarez of Nationwide Children’s Hospital to talk about their work examining the prevalence of and even the concerns surrounding digital dating violence among adolescents.
(01:25):
But before we could talk about the problem, we needed to define at least one concept that our guests were examining in their research and that we keep coming back to over and over again in our conversation. And that is the concept of dating. So here’s PIT researcher Emily Egbert to talk about the definition she used in her research.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (01:49):
For our study, we decided to keep it very broad. So we included talking with somebody consistently. We included levels of what the young people call a soft launch, meaning they might not have formally defined the relationship or formally claimed that they’re in a relationship on social media, but that there might be a hint of somebody else in the photo or the back of somebody’s head or things like that.
(02:12):
And for the digital dating violence and kind of social media coercion part of the discussion, we also included if you’re kind of FaceTiming somebody regularly or other things like that, interacting with them on different platforms because we know for young people dating looks very different today than it did kind of maybe when we were all teens. And so we try to keep that definition as broad as possible to include every kind of iteration of intimate relationship or romantic relationship.
Carol Vassar, podcast host/producer (02:41):
Dr. Alvarez, you’re nodding your head. Would you say generally that’s where you were in the ballpark?
Dianne Alvarez, DO, Nationwide Children’s Hospital (02:46):
Yeah. I would say in our study we tried to distinguish forms of intimate partner violence, what we know as whether it’s emotional, physical, or sexual violence, and then digital violence, focusing more on the use of technology. So, like Emily said, adolescents are using different forms of social media that we haven’t seen in our time, but now we’re seeing now as well as video chatting, like FaceTiming, and text message use is what we focused on. So I would agree with the newer type of digital use of partner violence.
Carol Vassar, podcast host/producer (03:26):
I was not even aware that people like yourselves were studying intimate partner violence in the digital space. How much digital violence is showing up in that space in the youth age group? Dr. Alvarez.
Dianne Alvarez, DO, Nationwide Children’s Hospital (03:42):
Yeah. So, in our study of the teenagers that we surveyed in general well-child visits, we saw about a 20% who overall were positive for at least intimate partner violence or digital media violence. And then within that subgroup, we saw that there were age group differences. We saw peaks at 14 and 15 years of age who were involved in digital partner violence, as well as female and male, generally some differences. So we are seeing this more prevalent in our school-based health systems, in our general well-child visits. So it is something newer that we are studying, but a lot more studies definitely should be focusing more on the digital component of this.
Carol Vassar, podcast host/producer (04:32):
And your study was screening in that school-based health center atmosphere?
Dianne Alvarez, DO, Nationwide Children’s Hospital (04:38):
Yeah. So we looked specifically at the school-based health centers within Columbus, Ohio. So we serve a lot of the youth who are seen in our school-based health systems, and we also have mobile units who will see kids there. So the survey was conducted in both of those settings to capture a wider audience of children.
Carol Vassar, podcast host/producer (04:58):
And we’ll get back to that in a minute. Emily, tell me a little bit about your study, which is a little bit different. It was connected to another larger study that was going on.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (05:05):
Absolutely. And I just want to start by echoing what Diane said in terms of the prevalence, where we saw something very similar. So our study, like you said, is a little bit different. We were kind of piggybacking on a national study that was looking at tobacco and nicotine product use and, kind of, misinformation surround that on social media. And so one of our co-authors, she had received an RON grant to kind of do this nationally representative study through an Ipsos KnowledgePanel, which kind of works within a national framework to recruit a nationally representative sample, random sample of adolescents between ages 12 to 17 or so.
(05:43):
And so we tacked on some questions, one about social media coercion, which is within that kind of definition of digital dating violence, but really focused on via a social media platform and that relationship to adolescent relationship abuse and the nuances there of various forms of social media use, whether that was active versus passive use, as well as different platforms.
(06:08):
And so, what we found was some numbers very similar, honestly. Some studies we were citing were saying about 20% of adolescents who are dating experience digital dating violence. And we were seeing in our study that we found about 24% were experiencing social media coercion, and about 21% were experiencing adolescent relationship abuse, with a very significant increased adjusted odds if somebody experienced dating violence; they were much, much more likely to experience social media coercion as well.
Carol Vassar, podcast host/producer (06:41):
You used three terms there, and it’s almost like there’s a gradation. Talk about the difference between coercion, violence, and abuse.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (06:48):
That’s a very good question. So the way we define dating violence, I think, is pretty well aligned. Our study used something called the MARSHA-C, which is a newer screening tool that kind of abridges the longer form questionnaire of a dating violence screen. So it’s three questions. And the idea is to efficiently ask teens these questions because, especially after a long survey or if you’re getting too granular with an adolescent, you might kind of lose them or kind of accidentally have them close up a bit.
(07:20):
And then we had an investigator design question that was kind of getting at the term of social media coercion, which is basically asking somebody or having an interaction with somebody in an unwanted way or persuading somebody to engage in an act that they did not want to engage in via social media. And so it’s not quite a gradation, but it’s interrelated terms with distinct kinds of aspects to each thing.
(07:46):
And so the interplay, which I really like what Diane was talking about, we kind of focus more on this digital dating violence lens of it, but we’re hoping to explore kind of where Diane went a little bit and build off of her work and see how that digital dating violence is potentially connected to these other forms of dating violence.
Carol Vassar, podcast host/producer (08:05):
I want to ask Dr. Alvarez and Emily as well: what does this look like? Dating violence, dating social media coercion. How does it appear to somebody who maybe has never experienced it like myself?
Dianne Alvarez, DO, Nationwide Children’s Hospital (08:20):
Yeah.
Carol Vassar, podcast host/producer (08:20):
To the parents, to the pediatricians? What are the kids seeing?
Dianne Alvarez, DO, Nationwide Children’s Hospital (08:23):
Right. So some alarming signs that we tend to look out for in adolescents who may be going through this are signs of withdrawal, anxiety, depression, increased substance use that includes alcohol and drug use, smoking. So those are signs that we look for when we are doing a general adolescent screener in clinic-based settings. But I think red flags that we think of are when teenagers are describing, “Oh, my partner follows me on my location, and they really care about me,” which is a red flag. It’s alarming. That shouldn’t be happening. We know that.
Carol Vassar, podcast host/producer (09:07):
So the GPS geolocator, they’ve shared their location, and now their partner is, “Oh, I see you’re at CVS. I see you’re at the school”
Dianne Alvarez, DO, Nationwide Children’s Hospital (09:16):
Or the constant, “Where are you? Who are you with?” At first, it may be interpreted as, “Oh, they really care about me. They really care where I’m going, who I’m with, because they love me.” But not making that connection yet, that these are actually signs of an unhealthy relationship. And that is what we really have to be educating adolescents about. So those are some of the red flags we look at in clinic. Some of the emotional aspects that we see and actions that teenagers who are affected may take when they are affected by this type of violence.
Carol Vassar, podcast host/producer (09:48):
Emily.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (09:49):
I would echo a lot of the same. And one of the things that we talk about kind of in our study team is how important universal education surrounding what healthy relationships look like and what dating violence can look like is in tandem with screening, honestly. One thing that we’ve seen, and I think it is something that has been promoted in policies as well, including pediatric policies in terms of recommendations, is when we screen, whether or not somebody screens positive or negative for a form of dating violence, including that kind of short educational moment with a provider, with caregivers and other things like that, educating on what healthy relationships look like.
(10:27):
I think probably the three of us around the table, healthy relationships was not something that we necessarily were talked about in health class. And I know I actually was a teacher in my first job out of school, and it was something we worked really hard to include, but it was an unusual thing to include at the time. And we see teenagers especially consuming different forms of social media that might show unhealthy relationships or toxic relationships, and they might not even know that that’s abnormal or that that’s something that we don’t want to strive for.
(11:01):
And so actually some members of our study team have been working on different interventions in a clinical setting at the annual physical, I guess, where it’s built off of the same platform or design of where you give a child a book at their annual visit as a youngin. And adolescents receive this box that has a card game and different informational things, and the card game is geared towards an adolescent playing it with their caregiver. And it’s different questions, kind of like a question game, like what do you picture when you picture a healthy relationship on TV or movies? And it generates those discussions and gets those conversations going with the caregiver, which we’ve shown to be useful as well.
Carol Vassar, podcast host/producer (11:52):
That’s a very interesting way of bringing up the conversation, which can be a difficult conversation. Parents can’t go in gangbusters and screaming, “Hey, what’s going on?” I’m wondering, how do you introduce this conversation, Dr. Alvarez? And also, what was the screening like? You had this screening in the school-based health centers, and what were the kinds of questions that you were asking that kind of raised those red flags, if you will, that possibly this young person is in a relationship that isn’t as healthy as it could be?
Dianne Alvarez, DO, Nationwide Children’s Hospital (12:25):
Yeah. Two great questions. How we introduce this in our clinical setting is a framework-based discussion with parents and adolescents, saying as part of our routine well visits with all children over the age of 12 to 13, we have time aside just to talk with your child. This is something that we do with all teenagers. If there’s anything concerning to me regarding their safety or the safety of others, and that is something that we have to disclose.
(12:58):
So that brings up confidentiality, patient safety, and disclosures that may occur during these conversations, which are all important things to consider. And most parents are agreeable. Some patients are okay with their parents saying if they feel like they have an open discussion relationship with their parents. Others are okay with them stepping outside for these discussions. So part of our routine screeners for adolescents, we talk about safety at home, safety at school, any exposure to alcohol, drugs, substance use, depression. And that’s where we implemented our screener was as part of our adolescent screeners for depression, anxiety. Then we introduced the intimate partner or violent screener.
(13:42):
The questions that we ask, our first three questions more and more general, do you feel safe in your relationship? Have you ever been physically hit by a partner? And then our last three questions focused more on social media: Have you ever been pressured to send a sexual photo to a partner? Have you ever been pressured to do something that you didn’t want to do via social media, such as sending other types of text message forms, or being unfriended on social media or geolocation? It wasn’t exactly a question, but we did say, “Did your partner have access to your social media passwords?” Which is a form of control, right?
Carol Vassar, podcast host/producer (14:24):
Yeah.
Dianne Alvarez, DO, Nationwide Children’s Hospital (14:25):
So, for patients who may have answered yes to any of those questions, we further did some motivational interviewing as to exploring why they may have answered that question. And of course, if there were safety concerns, that is definitely where we involve parents, social work, coming up with a safety plan for these patients.
Carol Vassar, podcast host/producer (14:45):
Coming up with an entire team to help them out.
Dianne Alvarez, DO, Nationwide Children’s Hospital (14:48):
Entire team. Yeah.
Carol Vassar, podcast host/producer (14:48):
What were some of the results? I know you didn’t have direct contact with it; it was a general questionnaire within that particular survey. What were some of the things that might have aligned with Dr. Alvarez’s study that you also found with regard to introducing the conversation?
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (15:06):
Absolutely. And I think it aligns somewhat with this study and also with that other one that I was just mentioning that the group is currently working on. But in terms of introducing things to families, when we were recruiting adolescents and their families to the other study that involved that box of materials, I was one of the people actually placing those recruitment calls. And sometimes when we would tell parents, “Hey, we’re recruiting for this study where it’s just part of your annual health visit. Would you like us to talk with your teen about relationships?” The vast majority were like, “Yes, please. We would love for you to introduce that conversation.”
(15:42):
And I think the most heartwarming conversation we had is mother said that, and then you could hear her daughter next to her being like, “Oh my gosh, I need this so much right now.” And then the daughter hopped on the phone and was talking about how she had just come out of what she felt was an unhealthy relationship and didn’t really have the words for it. And it was one of those moments where you imagine that that might be a conversation you’re going to have, but having that even in those recruitment calls was very validating, and we are meeting a need that’s not being discussed.
(16:15):
And that’s especially true because teens do have access to so much information these days. I think they’re hungry to understand what’s going on with them, especially when they feel like something isn’t right, but might not have the words to talk about it. And so meeting them where they’re at with that education, whether that’s for themselves or we talk a lot about altruism with adolescents as well, even if the knowledge doesn’t necessarily impact their own relationship immediately or they’re not dating yet, it might help their friend or somebody else in their class or something like that. And that can have a ripple effect that is just profound.
Carol Vassar, podcast host/producer (16:50):
Dr. Alvarez, you talked about what can be done. What kinds of education need to be done on a broader level in your estimation to raise awareness of this issue? I mean, we do know about intimate partner violence. We do know that it affects the youth of our nation. Is there anything that we can do in the prevention world to raise the profile of this issue so that we can work toward preventing it as a community and from a public health perspective?
Dianne Alvarez, DO, Nationwide Children’s Hospital (17:21):
Yeah. So there are definitely resources out there: websites, curriculum. So specific for teachers who may be having, or school nurses who may be having discussions during their health class about what is sexual health. So that is definitely something that could be tied in. Of course, sometimes that entails parents giving consent for their child to get any sort of teaching about sexual health at school.
(17:52):
So there are definitely ways to implement this in a school-based health setting by providing that education, whether it’s teachers, school nurses, or if they are seeing a provider, whether it be our physician or nurse practitioner team, to allow for that education. I think something to know is using language that teenagers recognize and understand. So our hospital actually has a campaign about green flags.
(18:21):
So, knowing what a green flag is versus a red flag, everyone knows what red flags are, but not a lot of teenagers recognize what are examples of healthy relationships. So I think it’s important to build rapport, use language that teenagers understand, and really get to their level as to what they know about relationships, and what else can we do to acknowledge them about healthy relationships.
Carol Vassar, podcast host/producer (18:46):
Emily, you’re nodding your head. From a public health perspective and from a broader community prevention perspective, what can we do?
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (18:55):
I think a lot of what Diane said is a great place to start, and that needs to happen in a clinic. And I think in addition to that, like you’re saying, from a public health perspective, one of the things that we’re talking about as kind of a follow-up to our study is really getting into the nitty-gritty about particularly how active social media use or platforms that require more interaction are potentially greater factors or they’re associated with greater odds of experiencing social media coercion and dating violence.
(19:24):
And so we’re hoping to look further into what specific aspects of platforms like that or that activity is contributory to that risk and hopefully working on more prevention programs and, honestly, policies that protect and support the healthy relationships and kind of growth to adulthood of these adolescents.
Carol Vassar, podcast host/producer (19:44):
By no means is this limited to social media, but I’m curious about the platforms where this kind of behavior shows up more. And I think one of your studies, and I’m having trouble remembering which one, indicated that some social media platforms were… This was more prevalent, if you will, and it was kind of surprising to you. Emily, was that yours?
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (20:08):
Yes.
Carol Vassar, podcast host/producer (20:09):
It was. Tell us about that.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (20:11):
That was something that we were kind of intrigued to know just because the scene of social media has changed so much over the past couple of decades and, in particular, over the past few years. And so we anticipated platforms that adolescents use more would by default be ones that place them at an increased odds of experiencing social media coercion, but that wasn’t necessarily the case. It was platforms that might have fewer regulations around who you’re interacting with, or who can post, or maybe who have tones of maybe being harsher in interactions. And then also ones like Diane was saying that have those geolocation components to them.
Carol Vassar, podcast host/producer (20:51):
Which Snapchat is one of those…
Dianne Alvarez, DO, Nationwide Children’s Hospital (20:52):
Yes.
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (20:53):
Yes, it is. And that was something that came up, and I know it was relevant back when we were young, and it’s had this resurgence. And so, there’s many elements to the instantaneous nature of that. There’s many elements of the geolocation and following and potential risk of unhealthy relationships, not just in the moment, but post-relationship who has access to what the passwords, where you are, safety issues related to that. And it’s hard to say.
(21:22):
Somebody brought up a great question in our session: is that an aspect of the platform or of the people that are naturally engaging in that platform? And it’s hard to parse those two things, but both parts are necessary components to lead us to what we were finding, and we need to delve more into why that is and what we can do about it.
Carol Vassar, podcast host/producer(21:41):
And part of it was also whether the platform was more passive in its analytics. So in TikTok, you’re scrolling, you’re looking, you’re not necessarily interacting and engaging and going back and forth. Whereas other platforms, surprisingly, Facebook, I think, showed up, which is the old person’s social media that showed up in your study, didn’t it?
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (22:04):
Yeah. It was Snapchat, Facebook, and X that actually had the highest odds of relationship with social media coercion, which we were somewhat surprised by. We thought similarly. I think TikTok is the most popular platform with teens these days, to some degree. But like you were saying, active social media use was the real finding from the study, and those more active interactive platforms, because when you’re scrolling through social media, that might be where most of your time is being spent, but it doesn’t necessarily mean you’re interacting and maybe isn’t the point of, I guess, switching around to some form of violence or coercion.
Carol Vassar, podcast host/producer (22:46):
Dr. Alvarez, we’re finishing up today. What’s next for you and for this study now that it has been presented here? Where do you want to take it next? What are the questions that still need to be answered?
Dianne Alvarez, DO, Nationwide Children’s Hospital (22:57):
Yeah. I think something important to know is right now there’s no validated screening tool for children as young as 12 years old. Most of the screening tools out there nationally are for 18 years and up. So there is a proposal by one of the national committees who reviews screening tools in all healthcare settings for 2027 to expand to a younger age group. So I think that will be very important to have a validated screening tool to then go out to other hospitals and institutions that may possibly use that.
(23:32):
Locally within our institution, my hope would be to expand the screener to other health settings. So whether that be our resident primary care clinics, other departments who could continue to do screeners within the clinic setting. So I think, personally, that’s my goal would be to expand the screener and hope for a validated screener for a younger age group.
Carol Vassar, podcast host/producer (23:53):
It sounds like it’s scalable, which is what we want to have with something that’s successful. Exactly. Yeah. Emily, last word. Where do you want to go from here? What questions do you want to have answered based on your experience here in the research you’ve done?
Emily Egbert, Researcher, University of Pittsburgh School of Medicine (24:06):
I think what we’re hoping to do is we’re hoping to build off of the national study that we kind of pulled from and explore kind of the relationship between tobacco and nicotine product coercion and use with different forms of coercion like social media coercion and dating violence at large and see if there’s a consistent story there in terms of how adolescents interact with each other or with information on social media. And then beyond that, kind of like we were talking about, making sure that we’re using the information to develop education tools and prevention programs as well as policies that can help protect and prevent both social media coercion and adolescent relationship abuse going forward.
Carol Vassar, podcast host/producer (24:47):
Emily Egbert is with the University of Pittsburgh School of Medicine. We also heard from Dr. Diane Alvarez, a resident physician at Nationwide Children’s Hospital in Columbus, Ohio.
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Carol Vassar, podcast host/producer
Thanks to both Dr. Alvarez and Emily for the research and work they are doing on this tough issue facing teens today. And, of course, thank you for listening.
Raising the issues and looking into the research that leads to solutions – just one part of the work we do here on the Nemours Well Beyond Medicine Podcast. Missed an episode? Want to subscribe to the podcast or our monthly e-newsletter? Just head over to nemourswellbeyond.org and listen to any or all of our 200-plus podcast episodes! It’s also a place to leave a review or an episode idea! That’s nemourswellbeyond.org. The podcast is also available wherever you find your favorite podcasts, including YouTube.
Our production team for this episode includes Lauren Teta, Cheryl Munn, Susan Masucci, and Alex Wall. Video production by Josh Hansbrough. Audio production by me. I’m Carol Vassar. Join us next time for the second part of a series on maternal-fetal health, as we explore how a well-designed clinical environment becomes an intricate part of a new baby’s treatment plan. Until then, remember, we can change children’s health for good – well beyond medicine.
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